Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tim B Gannon, PA

Individual provider Medical Physician Assistant · NPI 1780992024

Tim B Gannon, PA is a Physician Assistant in Santa Fe, New Mexico. Qualified in 2010, 16 years ago. Practices with Southwest Care Center, a 28-clinician group and accepts Medicare assignment. Licensed in New Mexico.

Years since qualifying
16
Licensed in
NM
In the registry since
2010
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

649 Harkle Rd Ste E
Santa Fe, NM 87505-4765
Phone: (505) 955-9454
Fax: (505) 216-9067
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA2010-0058 (NM)

Record details

NPI number1780992024
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 21, 2010
Last updated in NPPESMarch 26, 2026
Certification dateMarch 26, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Southwest Care Center — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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